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Inspection on 27/10/08 for The Yelverton Nursing and Residential Home

Also see our care home review for The Yelverton Nursing and Residential Home for more information

This inspection was carried out on 27th October 2008.

CSCI found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home is comfortable and friendly. There is laughter and banter and visitors are welcomed. People have their health care needs fully assessed and from this their care is planned. Staff know the needs of people. Where those needs are complex the home seeks additional advice. People are treated with respect and kindness. The standard of activities provided is very high. Where people do not wish to participate in group activities they are able to spend some one to one time with an activities worker, for example reading to them. The provider takes people out two or three times a year to a local restaurant. Staff know how to protect people from abuse and complaints about the service are taken seriously and always recorded as they should be. The home is warm, light, very clean and mostly fresh. It is `homely` and people like their rooms which have been personalised. The laundry service received praise. Good practise is used when staff are recruited so that those who might not be suitable to work with vulnerable adults are not employed. Staff are well trained and supported. Good teamwork was mentioned by staff and a general practitioner who visits the home and we saw this. Staff are well led, the manager is experienced and keeps herself up to date with modern practise. The home has good methods for checking that the service they provide is of a satisfactory standard.

What has improved since the last inspection?

There were no previous unmet requirements for the home to meet.

What the care home could do better:

People who have been assessed must be informed, in writing, by the home that their needs can be met. This protects both them and the home and helps prevent misunderstanding. A better medicine stock control system needs to be introduced so no out of date medicines are left in the home. Where a medicine is prescribed to be taken `as required` or `as necessary` it must be clearly recorded under which circumstance it may be administered so that its use is consistent. Safeguarding and complaint policies and procedures need some clarity and a review of the information they contain, so that all are clear as to how to proceed if they have complaints or concerns. All necessary equipment should be available, bathroom facilities should be within a reasonable distance from people`s rooms (not on a different floor) and the water system at the home not be a disadvantage to staff and therefore also people who need to use it. Where ramps are needed they should be provided and all potential hazards, such as garden paving stones, which may be slippery or a trip hazard, should beassessed.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Yelverton Nursing and Residential Home 2-4 Greenbank Terrace Yelverton Devon PL20 6DR     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Anita Sutcliffe     Date: 2 8 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: The Yelverton Nursing and Residential Home 2-4 Greenbank Terrace Yelverton Devon PL20 6DR 01822852641 01822854419 peter.james@yelverton-nursing-home.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : LarkCastle Limited care home 33 Number of places (if applicable): Under 65 Over 65 3 24 27 dementia old age, not falling within any other category physical disability Additional conditions: 0 0 0 The maximum number of servic eusers who can be accommodated is 33. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia - over 65 years of age (Code DE(E)) - maximum 3 places Old age, not falling within any other category (Code OP) - maximum 24 places Physical disability over 65 years of age (Code PD(E)) maximum 27 places Date of last inspection Brief description of the care home The Yelverton Nursing and Residential Home is a privately owned care home registered for up to twenty-seven residents within the categories of Old age, not falling within any other category (18), Physical disability over 65 years of age (27), and Dementia - over 65 years of age (3). It is not registered to provide intermediate care. The Yelverton Nursing and Residential Home is a refurbished Edwardian house that has been successfully modified over the years to provide nursing and residential care. The home Care Homes for Older People Page 4 of 28 Brief description of the care home is on three floors with passenger lift or stair lift access to all parts of the building. It offers a variety of accommodation, to include two double rooms and many rooms with en suite facilities. There is a pleasant patio approach to the home and a large patio area at the rear. The home employs registered nurses to deliver nursing care and to support care staff in the delivery of care. The home is well equipped to deliver the care for which it is registered. The home is very close to Yelverton village and there is level access to local amenities. The fees at The Yelverton Nursing and Residential Home range from £380 to £620 for single occupancy of a double room. Additional extras are nursing care, and hairdressing, chiropody, newspapers, special interest journals and magazines, dry cleaning, glasses, clothes, and any sundry items, all at commercial rates. There is also a fee for a hospital car to provide transport to hospital appointments with an additional fee for an escort. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Information about this home has been collected since the last key inspection March 2007. The home completed the annual quality assurance assessment toward this inspection giving us information on how well they judge the service they provide and some factual data such as number of people at the home and number of staff employed. We also sent surveys to people who use the service and staff so they could comment about the home. This key inspection included two unannounced visits to the home one an evening visit. We were accompanied for the day time visit by an Expert by Experience. They are people who, because of their shared experience of using services, and/or ways of communicating, visit a service with an inspector to help them get a picture of what it is Care Homes for Older People Page 6 of 28 like to live in or use the service. He joined people for lunch at the home. As part of the visit to the home we looked at all communal areas, and several bedrooms. We spoke to several people living there, the manager, staff and observed staff going about their work. We looked closely at the care and support that three people received. We looked at written records, including that of the care provided and staff recruitment and training. People who use the service may be described within this report as residents, clients or service users. What the care home does well: What has improved since the last inspection? What they could do better: People who have been assessed must be informed, in writing, by the home that their needs can be met. This protects both them and the home and helps prevent misunderstanding. A better medicine stock control system needs to be introduced so no out of date medicines are left in the home. Where a medicine is prescribed to be taken as required or as necessary it must be clearly recorded under which circumstance it may be administered so that its use is consistent. Safeguarding and complaint policies and procedures need some clarity and a review of the information they contain, so that all are clear as to how to proceed if they have complaints or concerns. All necessary equipment should be available, bathroom facilities should be within a reasonable distance from peoples rooms (not on a different floor) and the water system at the home not be a disadvantage to staff and therefore also people who need to use it. Where ramps are needed they should be provided and all potential hazards, such as garden paving stones, which may be slippery or a trip hazard, should be Care Homes for Older People Page 8 of 28 assessed. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that their needs will be known prior to admission, which will be handled in their best interest. Evidence: We looked at how people are admitted to the home. Of the eight people who responded to surveys six said they had received a contract on admission one adding: Clear and easily understood. Asked if they received enough information about the home seven said yes and one said no. Comments included: I had little time to choose. The initial impression was favorable and this has been born out by experience. One person met said they had come to look round, their care manager was involved but they made the choice about the home. The manager of the home reports that they encourage prospective residents to spend Care Homes for Older People Page 11 of 28 Evidence: time at the home if they are able and the inquiry form has been updated to give more relevant information and the brochure updated also. We saw people viewing the home during our visit. Staff took time to show them around and answer questions. We examined the care of the last person to be admitted. They were unable to discuss their admission with us due to frailty. The assessment of their needs contained sufficient detail from which a plan of how staff should deliver their care could be started. Risks were assessed, such as falls and the likelihood of pressure sores. We spoke with staff and the manager who described what care was needed. The person looked comfortable the twice we visited them. She was able to reach the bell to call staff and had some specialist equipment in place to protect her. We found that currently people do not receive written confirmation that their assessed needs can be met by the home. This confirmation protects both the person and the home as expectations are clearer from the outset. It is also a legal requirement. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure their personal and health care needs will be met and they will be treated with respect. Evidence: We looked at how well the home meets peoples personal and health care needs. Five people who completed surveys said they always receive the care and support they need and three said they usually did. All said they received the medical support they needed. We saw from the homes own quality assurance surveys that health care professionals who attend the home are very satisfied with the service. Comments included: A very good home. Staff always helpful and some good teamwork and They see to the health care needs extremely well. We looked closely at the care delivered to three people who use the service. Each had a comprehensive plan to inform staff how their care should be provided. Risks had been considered and measures taken to reduce risk, such as pressure relieving Care Homes for Older People Page 13 of 28 Evidence: equipment. Where one person refused care the staff were liaising with their doctor and meeting their duty of care to the best of their ability within the circumstance. Care plans were reviewed regularly and people had signed to say they agreed with their plan of care. We did two unannounced visits to the home. There had been a complaint about the standard of personal care and hygiene of one person who uses the service. We saw no evidence of this. Both times she looked clean and well cared for and we saw monitoring records of the care provided. The eight staff who responded to surveys said they are always given up to date information about the needs of people. Their comments included: We always have an up to date report on the start of each shift and If there are any changes we are always informed straight away. We looked at how the home manages medicines. The manager told us there are no people currently handling their own but when people wish to any associated risk is considered. We found that the medicines were stored safely and only available to designated staff. The medicine records had been properly completed so reducing the likelihood of mistakes. There were records of all medicines brought into, and leaving, the home as there should. However, we found a small amount of very out of date medicines. This might pose a danger if used. We also found that where medicines were prescribed to be given as necessary or as required there was no information for staff on the circumstance under which they could be administered. This might easily lead to inconsistent use. We saw that staff were friendly and pleasant with people and one confirmed they are always treated with respect. We also saw staff knocking before entering peoples rooms. One staff said: All clients are treated with the utmost respect at all times and their individual needs are met regardless of how many service users there are. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are helped to enjoy a very good quality of life at The Yelverton. Evidence: We looked at daily life in the home, social activities and food provided for people who use the service. There is a full programme of activities advertised in a hallway and people were aware of the activities available to them. Staff said the activities programme is adhered to. It includes: musical events, exercise sessions, quizzes, Communion and a pat dog visiting. We saw people having hair and manicure attention. Recently the provider and manager took thirteen residents to a local restaurant for a meal; something people told us happens two or three times a year. The home is a member of the Cinnamon Trust and therefore people are able to bring pets with them to the home; currently there are none. The expert by experience was told there is an activities organiser at the home. She takes some group activities and also spends individual time with people, we are told sometimes reading to them. This gives people who dont like or are unable to join Care Homes for Older People Page 15 of 28 Evidence: group events a social option, helping to prevent isolation. The provider reports that visitors are welcome at any times. We met visitors who confirmed this and saw staff bring tea and biscuits for them, something the visitors told us happens automatically although never requested. We saw staff offering people choices and staff said told us those who prefer early or late rising. People have a key worker alloted to them who might go to the shops or liaise with family to get personal items. Peoples rooms were individual to them and many people have brought their own items of furniture. Opinion about the standard of food was mixed. Three said through survey that they always liked the food, four said usually and one said sometimes. Comments included: Please could we have smaller portions and Provision of condiments, sauce etc. could be better. A visitor said that the only fault was the food and catering. The expert by experience was told: As good as it can be when you are cooking for a lot of people. People confirmed that they have a choice of menu and one said they choose the main meal on their birthday. People were not aware of being asked for their favourite meal or suggestions for a change of menu. The expert by experience shared a meal with people. The options were sausage and mashed potato or fish pie with cheesy mashed potato, both with green beans, carrots and a choice of hot or cold sweet. Both main meals were served plated and were hot and well presented. The dining room is spacious and clean but some people choose to eat in their room. We saw staff assistance with eating given in a discreet manner. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although people are protected by the homes complaints and safeguarding arrangements both could be further improved. Evidence: We looked at how well people are protected by the homes complaints and safeguarding arrangements at the home. The complaints procedure is displayed in the entrance hall of the home and the provider reports that a copy is sent to prospective residents in a brochure pack. The procedure contains the Commissions contact details but does not make it clear that we can be contacted at any stage of a complaint, not only if dissatisfied with the handling of a complaint at the home itself. Asked through survey if they know who to speak to if they are not happy five people said always, two said usually, one said sometimes and one said never adding: It seems to be only my concern that I am unhappy. Asked if they knew how to make a complaint nine people said yes and one said no. The home has recorded several complaints. This indicates that they are keen to ensure complaints are managed not that there are an unusually large number of things to complain about. People told the expert by experience: Never dissatisfied at all, this is Care Homes for Older People Page 17 of 28 Evidence: a nice place, No grumbles and Nothing to complain about here. The manager was highly visible, assisting and speaking to staff and people in the public areas throughout the day time visit. There is also information about where to find advocacy should people need this service. Before this inspection we received one complaint about the home. We found no evidence to substantiate it. We asked staff their understanding of what to do should they have concerns which might be abuse. They were able to tell us who they should contact with those concerns. Staff receive training in the safeguarding of vulnerable adults and have video and written information about it. However, when we were shown the homes whistle blowing policy, which should provide information about how to alert concerns, and discussion with the manager about it, the written informationremained unclear. The policy lacked any information about the Local Authority Safegurding team and who should, or should not, investigate concerns raised. Nor did it explain how staff are protected should they feel they must alert any concerns. There have been no safeguarding concerns raised about the home. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although a very pleasant and homely environment it does not meet the needs of all the people who currently live there. Evidence: We looked at how suitable and comfortable the home environment was for people. On both visits we walked around the home and both times it was warm, clean and appeared comfortable and well furnished. A visitor told us how much they liked that it was like a mini hotel. Asked through survey if the home is fresh and clean five people said always and three said usually with comment: Cleaning staff are excellent. We twice visited a room where a complainant reported it to be unclean and very smelly. There was a mild odour in the en suite but it looked clean and the bedroom was fresh. We discussed renewing the flooring in the en suite. The kitchen was very clean and we saw a very detailed cleaning plan, clearly being followed. Bedrooms were individual, comfortably furnished and many people had brought their own furniture or items of importance. People told us they had what they needed in their rooms. However, one person complained: The bathroom adjacent to my bedroom is not suitable for me to use...this means a long trek in one direction for a shower and the same the other direction to reach a suitable bathroom. It was Care Homes for Older People Page 19 of 28 Evidence: confirmed that this was the case and the manager was aware of it. One person said through survey that it would be beneficial to more people if an under-utilised bath was replaced with a shower. Staff told us through survey and in person that they need the use of a stand-aid, to help people stand where their mobility is poor. They described having to move furniture around in one bedroom so as to be able to use a hoist and that the person in question did not like it. Staff said they asked for a stand aid at a staff meeting last year. They also described temperamental water temperature and flow on the top floor of the house, adding that the only usable bathroom is on the ground floor. However, one added that when things go wrong it is usually coped with very well. Although some parts of the home have level access for people with poor mobility there are steps, for example at the front entrance and from some ground floor bedrooms into the garden. This will reduce peoples independence around the home. We also discussed the paved garden area and the potential for it to be a trip hazard. The manager felt it was not a hazard but said this had not been formally risk assessed. We saw staff using protective clothing to reduce the likelihood of cross infection and staff said the laundry was suitable for the needs of the home. The standard of laundry at the home received special praise from some people who use the service. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from a staff which is properly recruited, in sufficient numbers to meet peoples needs and trained, skilled and competent in their work. Evidence: We looked at how effective the staffing arrangements are. One person said through survey: I am very happy here. The staff are friendly and I have enjoyed my time here. Staff were considerate (bringing tea and biscuits to visitors without being asked) and the expert by experience heard a meaningful conversation between a cleaner and person in their room. We only observed kind, considerate and unhurried interaction as staff did their work. Many staff have worked at the home for a long time, providing continuity for people who use the service. Asked through survey if staff are available when they need them seven people said always and one said usually. Asked through survey if there are enough staff to meet the individual needs of people who use the service two staff said always and six said usually with comments including: There is only shortage due to sickness or holidays. Normal quota is more than adequate and We are able to get through happily and clients always get the care and time they need. Our evening visit one staff was sick and another was arriving to take her place as we arrived. Part of a recent complaint Care Homes for Older People Page 21 of 28 Evidence: about the home included lack of staff in the evenings but we did not find this to be the case. People told the expert by experience that the call bell response time was good both day and night and he observed staff were arriving within four minutes. However, several people told him that staff do not always have the time to stop and chat as they would like. Staff told us they are impressed by the standard of training, one adding: Excellent. They say induction (training when new) is done very well. The staff added that they were made to feel very welcome. Others said: We are provided with training which allows us to deal with all sorts of different clients and their different needs. We spoke to care staff, nursing staff and domestic staff who described a wide range of training. In addition, the manager is very proactive in ensuring staff understand the training that is provided. Staff told us that five care staff have achieved their National Vocational Qualification (NVQ) 2 in care (an indication of their competence) four have achieved NVQ 3 and all care staff are automatically put on the NVQ programme when they work at the home. We looked at the recruitment records of the last two staff employed at the home and one application not yet complete. We found that the necessary checks, to see if a person is unsuitable or unsafe to work with vulnerable adults, had been completed. Of staff asked through survey if those checks are completed before they started work at the home all said yes. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a commitment to a high standard of service at The Yelverton. Evidence: We looked at the way the home is managed and how this affects the people who live there. People who use the service said of the home: They look after me very well here, you can have anything you want and Never dissatisfied at all. This is a nice place, one of the best. The manager (known as matron) is a qualified nurse with many years experience of running the home. She also has a qualification in management. She and the deputy were highly visible during the day time visit, assisting and speaking to people who use the service and staff. One person told the expert by experience: Sometimes matron (the manager) consults me on how the staff perform and behave and I am Care Homes for Older People Page 23 of 28 Evidence: pleased to tell her. We found staff had a very positive attitude to their work and were keen to provide a good service to people. One said: I have worked at the home for several years and I can honestly say it is the happiest home I have worked in and I believe the service users feel the same, because I feel that we are their extended family. Listening to humour and banter between staff and people, staff bringing tea and biscuits without being asked, and observing staff going about their duties in a relaxed manner, we found the ethos of the home to be very pleasant. It is also of considerable note that the provider takes people out to a local restaurant for a meal two or three times a year. The standard of activities, and of daily life, is rich. The way the quality of the service is assessed is reviewed at the home each year. Questionnaires are given to people, their relatives, staff and visiting professionals every year. We looked at those from visiting professionals and they were complimentary, one doctor saying: A very good home. Staff are always helpful and you can see teamwork. Staff confirmed that information about people is passed between staff (and the manager) effectively and that they have staff meetings to give opinion and information. The manager confirmed that the registered provider does the required unannounced visits to the home to speak with people and check the service provided meets that which the home says it will provide. The manager told us that no person at the home is currently handling their own financial affairs and the home is not keeping any money for people. The registered manager told us that equipment is serviced and kept in a good state of repair. Staff are properly trained in health and safety. We saw that people had risks assessed which were individual to their health care needs, such as that of falling or pressure sores. However, the breadth of general risk assessment seemed to be narrow, for example, not including paving slabs in the courtyard (which may be slippery or uneven) or the steps to and from the home. The environment, although homely and pleasant, does not meet some peoples needs in that it restricts independence and it raises the risk of trips and falls. It was disappointing that a standaid hoist was not available for staff use. The inadequate bathing arrangements must disadvantage staff and certainly annoy people who use the service. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 (1)(d) The manager must write to confirm that a persons assessed needs, especially regarding their health and welfare, can be met. This protects both the person and the home as expectations on both sides can be made clear. 30/11/2008 2 9 13 (2) It must be part of planned care as to under which circumstance medicines prescribed to be given as necessary or as required will be administered. To ensure that staff are consistent in their decision to administer them. 30/11/2008 3 21 23 (2)(j) Each person must have access to a bath or shower room, with a water system which is suitable to their needs, that is 30/06/2009 Care Homes for Older People Page 26 of 28 reasonably close to their bedroom. For comfort and dignity. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 9 16 The system for stock control should be improved so that out of date stock is promptly removed. It should be clear within the homes complaints policy that the Commission can be contacted at any stage of a complaint, not only if dissatisfied with the way a complaint is handled at the home. The homes whistle blowing policy should include clear and accurate information including how staff are protected under the Public Interest Disclosure Act 1998 and how the home should respond should a concern be raised which might be abuse. There should be a stand-aid available to staff so that peoples independence is maximised and staff do not have to use a hoist where there is insufficient room and it is not the equipment of choice in the circumstance. 3 18 4 22 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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